Evaluation of the safety and efficacy of low-dose rasburicase in critically ill children with haematological malignancie
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RESEARCH ARTICLE
Evaluation of the safety and efficacy of low‑dose rasburicase in critically ill children with haematological malignancies Yuxin Pei1 · Yu Li1 · Yujian Liang1 · Lingling Xu1 · Xueqiong Huang1 · Yijuan Li1 · Wen Tang1 · Xiaoyun Jiang1 Received: 14 May 2020 / Accepted: 2 September 2020 © The Author(s) 2020
Abstract Background The recommended dose of rasburicase is quite expensive, thus limiting its use. Whether a lower dose of rasburicase would be equally effective for critically ill children, who often have more complicated situations and a higher risk of hospital death, is still unknown. Objective To explore the safety and efficacy of low-dose rasburicase in critically ill children with haematological malignancies who are at high risk of tumour lysis syndrome. Setting A single-centre retrospective cohort study. Method Children with haematological malignancies who had a history of rasburicase exposure during an intensive care unit stay were enrolled. Patients were divided into two groups according to the initial dosage of rasburicase: the standard-dose group (> 0.1 mg/kg/day) and the low-dose group (≤ 0.1 mg/kg/day). The adverse events and short-term prognosis of the two groups were compared. Results Thirty-seven children were selected, 22 in the standard-dose group and 15 in the low-dose group. The most common tumour type was Burkitt’s lymphoma (81%), followed by acute lymphoblastic leukaemia (11%). All patients were at high risk of tumour lysis syndrome, and 73% of them had 3 or more tumour lysis syndrome risk factors. The uric acid levels of 90% of patients with hyperuricaemia returned to the normal range within 12 h (100% in the standard-dose group and 75% in the low-dose group, P = 0.083). Eighty-four percent of patients presented serious complications, including tumour lysis syndrome (73%), acute kidney injury (59%), renal replacement treatment (24%), respiratory failure (24%), disseminated intravascular coagulation (16%) and heart failure (11%). There was no significant difference in the incidence of serious complications between the two groups. The overall 7-day and 28-day survival rates after intensive care unit admission were 86% and 84%, respectively. The average length of stay in the intensive care unit was 9.92 ± 5.13 days. Neither the short-term mortality nor the length of stay in the intensive care unit were significantly different between the two groups. Conclusion Low-dose rasburicase is effective and may be an acceptable choice for critically ill children with haematological malignancies. Keywords Children · Haematological malignancies · Hyperuricaemia · Intensive care unit · Rasburicase
Impacts on Practice • Rasburicase is recommended for children who are at high
risk of tumour lysis syndrome.
• This research provides guidance on using rasburicase
in children with a high tumour burden managed in the intensive care unit.
Yuxin Pei and Yu Li have contributed equally to the study. * Xiaoyun Jiang [email protected] 1
The First Affiliated Hospital of Sun-yat, Sen Un
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